Healthcare Provider Details

I. General information

NPI: 1720406903
Provider Name (Legal Business Name): ZUNI RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 D AVENUE BLACKROCK
ZUNI NM
87327-0000
US

IV. Provider business mailing address

PO BOX 339
ZUNI NM
87327-0339
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-4710
  • Fax: 505-782-5880
Mailing address:
  • Phone: 505-782-4710
  • Fax: 505-782-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AVA HANNAWEEKE
Title or Position: TRIBAL ADMINISTRATOR
Credential:
Phone: 505-782-7000